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Exchange Transfusion in Hepatorenal Syndrome With Liver Disease

Exchange Transfusion in Hepatorenal Syndrome With Liver Disease Abstract Ten patients with severe liver disease and the hepatorenal syndrome underwent exchange transfusions with 9 to 16 units of fresh heparinized blood to improve renal function by either removing a vasoconstrictive substance or adding a vasodilatory substance. One patient recovered from renal failure within ten days without showing natriuresis. The renal function of one patient improved somewhat, but he died 35 days after the transfusion. The other eight patients died from 1 to 35 days after exchange transfusion, without any appreciable improvement in renal function. In six patients, renin substrate levels increased after the transfusion, but renal function remained unchanged. The results of this study failed to support a humoral concept of pathogenesis of the hepatorenal syndrome. (Arch Intern Med 136:1135-1137, 1976) References 1. Schroeder ET, Shear T, Sancetta SM, et al: Renal failure in patients with cirrhosis of the liver: III. Evaluation of intrarenal blood flow by para-aminohippurate extraction and response to angiotensin . Am J Med 43:887-896, 1967.Crossref 2. Lancestremere RG, Davidson PL, Earley LE, et al: Renal failure in Laennec's cirrhosis: II. Simultaneous determination of cardiac output and renal hemodynamics . J Clin Invest 41:1922-1927, 1962.Crossref 3. Baldus WP, Feicheter RN, Summerskill WHJ: The kidney in cirrhosis: I. Clinical and biochemical features of azotemia in hepatic failure . Ann Intern Med 60:353-365, 1964.Crossref 4. McCloy RM, Baldus WP, Maher FT, et al: Effects of changing plasma volume, serum albumin concentration and plasma osmolality on renal function in cirrhosis . Gastroenterology 53:229-239, 1967. 5. Baldus WP: Etiology and management of renal failure in cirrhosis and portal hypertension . Ann NY Acad Sci 170:267-279, 1970.Crossref 6. Reynolds TB, Lieberman FL, Redeker AG: Functional renal failure with cirrhosis: The effect of plasma expansion therapy . Medicine 46:191-196, 1967.Crossref 7. Baldus WP, Summerskill WHJ, Hunt JC, et al: Renal circulation in cirrhosis: Observations based on catheterization of renal vein . J Clin Invest 43:1090-1097, 1964.Crossref 8. Tyler JM, Jeffries JL, Wilder CE: A study of the renal blood flow by nitrious oxide technique in normal and oliguric patients with cirrhosis of the liver . Clin Res 10:194, 1962. 9. Tristani FE, Cohn JN: Systemic and renal hemodynamics in oliguric hepatic failure. Effect of volume expansion . J Clin Invest 46:1894-1906, 1967.Crossref 10. Epstein M, Berk DP, Hollenberg NK, et al: Renal failure in the patients with cirrhosis: The role of active vasoconstriction . Am J Med 49:175-185, 1970.Crossref 11. Kew MC, Brunt PW, Varma PR, et al: Renal and intrarenal blood flow in cirrhosis of the liver . Lancet 2:504-509, 1971.Crossref 12. Baez S, Mazur A, Shorr E: Hepatorenal factors in circulatory homeostasis: XX. Antidiuretic action of hepatic vasodepressor VDM (ferritin) . Am J Physiol 162:198-212, 1950. 13. Berkowitz HD, Galvin CC, Miller LD: The control of renal cortical perfusion by the renin angiotensin system . Ann Surg 179:238-245, 1974.Crossref 14. Fischer JE, Baldessarini RJ: False neurotransmitters and hepatic failure . Lancet 2:75-79, 1971.Crossref 15. Reynolds TB: The hepatorenal syndrome , in Schaffner F, Sherlock S, Leevy CM (eds): The Liver and It's Diseases . New York, International Medical Book Corp, 1974, pp 307-313. 16. Koppel MH, Coburn JW, Mims MM, et al: Transplantation of cadaveric kidneys from patients with hepatorenal syndrome: Evidence for the functional nature of renal failure in advanced liver disease . N Engl J Med 280:1367-1371, 1969.Crossref 17. Iwatsuki S, Popovtzer M, Corman J, et al: Recovery from "hepatorenal syndrome" after orthotopic liver transplantation . N Engl J Med 289:1155-1159, 1973.Crossref 18. Barnardo DE, Summerskill WHJ, Strong CG, et al: Renal function, renin activity and endogenous vasoactive substances in cirrhosis . Am J Dig Dis 15:419-425, 1970.Crossref 19. Barnardo DE, Baldus WP, Maher FT: Effects of dopamine on renal function in patients with cirrhosis . Gastroenterology 58:524-531, 1970. 20. Ayers CR: Plasma renin activity and reninsubstrate concentration in patients with liver disease . Circ Res 20:594-598, 1967.Crossref 21. Schroeder ET, Eich RH, Smulyan H, et al: Plasma renin level in hepatic cirrhosis . Am J Med 49:186-191, 1970.Crossref 22. Berkowitz HD, Miller LD, Rosato EF: Renin substrate depletion in hepatorenal syndrome . N Engl J Med 290:461, 1974. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Exchange Transfusion in Hepatorenal Syndrome With Liver Disease

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Publisher
American Medical Association
Copyright
Copyright © 1976 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1976.03630100047013
Publisher site
See Article on Publisher Site

Abstract

Abstract Ten patients with severe liver disease and the hepatorenal syndrome underwent exchange transfusions with 9 to 16 units of fresh heparinized blood to improve renal function by either removing a vasoconstrictive substance or adding a vasodilatory substance. One patient recovered from renal failure within ten days without showing natriuresis. The renal function of one patient improved somewhat, but he died 35 days after the transfusion. The other eight patients died from 1 to 35 days after exchange transfusion, without any appreciable improvement in renal function. In six patients, renin substrate levels increased after the transfusion, but renal function remained unchanged. The results of this study failed to support a humoral concept of pathogenesis of the hepatorenal syndrome. (Arch Intern Med 136:1135-1137, 1976) References 1. Schroeder ET, Shear T, Sancetta SM, et al: Renal failure in patients with cirrhosis of the liver: III. Evaluation of intrarenal blood flow by para-aminohippurate extraction and response to angiotensin . Am J Med 43:887-896, 1967.Crossref 2. Lancestremere RG, Davidson PL, Earley LE, et al: Renal failure in Laennec's cirrhosis: II. Simultaneous determination of cardiac output and renal hemodynamics . J Clin Invest 41:1922-1927, 1962.Crossref 3. Baldus WP, Feicheter RN, Summerskill WHJ: The kidney in cirrhosis: I. Clinical and biochemical features of azotemia in hepatic failure . Ann Intern Med 60:353-365, 1964.Crossref 4. McCloy RM, Baldus WP, Maher FT, et al: Effects of changing plasma volume, serum albumin concentration and plasma osmolality on renal function in cirrhosis . Gastroenterology 53:229-239, 1967. 5. Baldus WP: Etiology and management of renal failure in cirrhosis and portal hypertension . Ann NY Acad Sci 170:267-279, 1970.Crossref 6. Reynolds TB, Lieberman FL, Redeker AG: Functional renal failure with cirrhosis: The effect of plasma expansion therapy . Medicine 46:191-196, 1967.Crossref 7. Baldus WP, Summerskill WHJ, Hunt JC, et al: Renal circulation in cirrhosis: Observations based on catheterization of renal vein . J Clin Invest 43:1090-1097, 1964.Crossref 8. Tyler JM, Jeffries JL, Wilder CE: A study of the renal blood flow by nitrious oxide technique in normal and oliguric patients with cirrhosis of the liver . Clin Res 10:194, 1962. 9. Tristani FE, Cohn JN: Systemic and renal hemodynamics in oliguric hepatic failure. Effect of volume expansion . J Clin Invest 46:1894-1906, 1967.Crossref 10. Epstein M, Berk DP, Hollenberg NK, et al: Renal failure in the patients with cirrhosis: The role of active vasoconstriction . Am J Med 49:175-185, 1970.Crossref 11. Kew MC, Brunt PW, Varma PR, et al: Renal and intrarenal blood flow in cirrhosis of the liver . Lancet 2:504-509, 1971.Crossref 12. Baez S, Mazur A, Shorr E: Hepatorenal factors in circulatory homeostasis: XX. Antidiuretic action of hepatic vasodepressor VDM (ferritin) . Am J Physiol 162:198-212, 1950. 13. Berkowitz HD, Galvin CC, Miller LD: The control of renal cortical perfusion by the renin angiotensin system . Ann Surg 179:238-245, 1974.Crossref 14. Fischer JE, Baldessarini RJ: False neurotransmitters and hepatic failure . Lancet 2:75-79, 1971.Crossref 15. Reynolds TB: The hepatorenal syndrome , in Schaffner F, Sherlock S, Leevy CM (eds): The Liver and It's Diseases . New York, International Medical Book Corp, 1974, pp 307-313. 16. Koppel MH, Coburn JW, Mims MM, et al: Transplantation of cadaveric kidneys from patients with hepatorenal syndrome: Evidence for the functional nature of renal failure in advanced liver disease . N Engl J Med 280:1367-1371, 1969.Crossref 17. Iwatsuki S, Popovtzer M, Corman J, et al: Recovery from "hepatorenal syndrome" after orthotopic liver transplantation . N Engl J Med 289:1155-1159, 1973.Crossref 18. Barnardo DE, Summerskill WHJ, Strong CG, et al: Renal function, renin activity and endogenous vasoactive substances in cirrhosis . Am J Dig Dis 15:419-425, 1970.Crossref 19. Barnardo DE, Baldus WP, Maher FT: Effects of dopamine on renal function in patients with cirrhosis . Gastroenterology 58:524-531, 1970. 20. Ayers CR: Plasma renin activity and reninsubstrate concentration in patients with liver disease . Circ Res 20:594-598, 1967.Crossref 21. Schroeder ET, Eich RH, Smulyan H, et al: Plasma renin level in hepatic cirrhosis . Am J Med 49:186-191, 1970.Crossref 22. Berkowitz HD, Miller LD, Rosato EF: Renin substrate depletion in hepatorenal syndrome . N Engl J Med 290:461, 1974.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1976

References